Substance Use During Pregnancy

Pregnancy is a period of transition with physical changes in the maternal body but also mental and psychological ones. This phase may be accompanied by symptoms of anxiety, depression or irritability, which are part of non-pathological adaptation mechanisms. These symptoms can, however, be intense and constitute real psychiatric syndromes, particularly when the woman presents vulnerability factors. While fetal exposure to alcohol and other drugs is one of the leading preventable causes of developmental delay and birth defects in newborns, substance use during pregnancy is common, particularly in Europe. There is no amount and no time during pregnancy where consuming alcohol and other substances of abuse is safe. This narrative review reflects the point of view of the obstetrician, the constraints of his therapeutic framework with its limitations of time, training and tools to detect and manage substance-related disorders. Validated detection questionnaires are poorly adapted to obstetric practice; detection and first brief interventions can be delegated to save time but at the risk of reducing the involvement of the obstetrician. The combined management of pregnancy and addictions by a psychiatrist and an obstetrician comes up against different frameworks and working deadlines in the two disciplines.